Progression from Normal to Reduced Left Ventricular Ejection Fraction in Patients With Concentric Left Ventricular Hypertrophy After Long-Term Follow-Up

• Published in: The American journal of cardiology Vol. 108; no. 7; pp. 997 - 1001
• Main Authors: Krishnamoorthy, Arun, MD, Brown, Timothy, BS, Ayers, Colby R., MS, Gupta, Sachin, MD, MSc, Rame, J. Eduardo, MD, MPhil, Patel, Parag C., MD, Markham, David W., MD, MSc, Drazner, Mark H., MD, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.10.2011; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular system; Disease Progression; Echocardiography; Female; Follow-Up Studies; Genotype & phenotype; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Hypertrophy, Left Ventricular - diagnostic imaging; Hypertrophy, Left Ventricular - physiopathology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Prognosis; Retrospective Studies; Stroke Volume - physiology; Time Factors; Ventricular Function, Left - physiology; Human; Prognosis; Patient; Normal; Long term; Left ventricle; Follow up study; Evolution; Ventricular ejection; Circulatory system; Hemodynamics; Cardiology; Ejection fraction; Hypertrophy
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2011.05.037

Whether concentric left ventricular (LV) hypertrophy (LVH) is a common precursor to depressed LV ejection fraction (EF) in humans is uncertain. From 1992 through 1994, 555 patients at our institution underwent echocardiography and had LVH (posterior or septal wall thickness ≥1.3 cm or concentric LVH noted) and normal LVEF. Of these, 220 (40%) had a follow-up assessment of LVEF by December 2008. The duration of follow-up was classified as short (≤7.5 years) or long (>7.5 years) term. The primary outcome was the development of a qualitatively depressed LVEF (mildly, moderately, or severely depressed). After a median follow-up of 7.5 years, 20% of the patients with concentric LVH developed a low LVEF. A low LVEF developed in 13% of subjects without interval myocardial infarction (MI) and 50% of subjects with interval MI during short-term follow-up (p <0.005). A low LVEF developed in 20% of subjects without interval MI and 44% of subjects with interval MI during long-term follow-up (p = 0.01). Of the subjects who developed a reduced LVEF, the relative wall thickness (median 0.5, 25th to 75th percentile 0.4 to 0.6) at follow-up was consistent with a concentric, rather than eccentric, phenotype. In conclusion, in patients with concentric LVH, the transition from a normal LVEF to a low LVEF was relatively infrequent (20%) after long-term follow-up in the absence of interval MI and usually did not result in a change in the LV geometry from a concentric to an eccentric phenotype.